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Mullis MD, Fisher CL, Johnson SB, Liu T, Amin TB, Rogers S, DeGruccio K, Bylund CL. Clinician-patient communication about cancer treatment misinformation: The Misinformation Response Model. PEC INNOVATION 2024; 5:100319. [PMID: 39101055 PMCID: PMC11296260 DOI: 10.1016/j.pecinn.2024.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 06/05/2024] [Accepted: 07/03/2024] [Indexed: 08/06/2024]
Abstract
Objective Cancer treatment misinformation (CTM) is pervasive and impacts patient health outcomes. Cancer clinicians play an essential role in addressing CTM. We previously identified four self-reported responses that characterize the communication process clinicians engage in to address CTM. Clinicians 1) work to understand the misinformation; 2) correct the misinformation through education; 3) advise about future online searches; and 4) preserve the clinician-patient relationship. We sought to confirm and expand on the model we developed by observing cancer clinicians' communication while addressing CTM with a standardized patient (SP). Methods 17 cancer clinicians were audio recorded in a SP encounter, in which a breast cancer SP asked three questions based on CTM. We thematically analyzed transcriptions of the recordings. Results Clinicians used four responses with associated strategies and skills to address CTM in a standardized clinical encounter, confirming the previously developed model. The four responses were: (1) work to understand the misinformation; (2) correct the misinformation through education; (3) advise about future online searches; and (4) preserve the clinician-patient relationship. This observational approach allowed us to refine strategies within each response and identify communication skills clinicians enact to address CTM. Conclusion These findings provide a strong foundation for the Misinformation Response Model for cancer clinicians. Future research should examine which components of the model are most effective in improving patient outcomes. Innovation This is the first study observing clinicians' communication through simulated practice with SPs about CTM.
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Affiliation(s)
- M. Devyn Mullis
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32610, United States of America
| | - Carla L. Fisher
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32610, United States of America
| | - Skyler B. Johnson
- Department of Radiation Oncology, School of Medicine, University of Utah, 30 N 19000 E, Salt Lake City, UT 84132, United States of America
| | - Tianshi Liu
- Division of Hematology/Oncology, Department of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, United States of America
| | - Tithi B. Amin
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32610, United States of America
| | - Sherise Rogers
- Division of Hematology/Oncology, Department of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, United States of America
| | - Kennan DeGruccio
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32610, United States of America
| | - Carma L. Bylund
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32610, United States of America
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Linn AJ, van Weert JCM, Bylund CL. Are They Important? Patients' Communication Barriers to Discussing Online Health Information During Consultations. HEALTH COMMUNICATION 2024; 39:945-950. [PMID: 37072688 DOI: 10.1080/10410236.2023.2197311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
A minority of the patients who search for online health information report discussing or having an intention to discuss this information with their healthcare provider. Not discussing online health information inhibits the provision of patient-centered care and limits the healthcare provider's possibility to tackle misinformation. Within the confines of the linguistic model of patient participation, we first provide an overview of barriers to discussing online health information during consultations. Second, we pinpoint which of these barriers indicate a need for improvement. Participants from the Netherlands (N = 300) completed a survey that measured the communication barriers (N = 15) as identified based on previous literature and interviews. Using the QUality Of Care Through the patient's Eyes (QUOTE) approach, we measured the extent to which a specific factor was a barrier ("importance") and assessed whether the barrier would withhold patients from discussing online health information ("performance"). Scores on importance and performance were multiplied to identify which barriers show the most significant room for improvement. Especially "preferring to discuss other matters" often occurred. Nine barriers showed a moderate need for improvement. We discuss the implications of these findings for healthcare providers in consultations. Future research should include observational data to analyze communication barriers to discussing online health information in consultations.
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Affiliation(s)
- Annemiek J Linn
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam
| | | | - Carma L Bylund
- College of Journalism and Communications, College of Medicine, University of Florida
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Bylund CL, Mullis MD, Alpert J, Markham MJ, Onega T, Fisher CL, Johnson SB. Clinician Communication With Patients About Cancer Misinformation: A Qualitative Study. JCO Oncol Pract 2023; 19:e389-e396. [PMID: 36626708 DOI: 10.1200/op.22.00526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Clinicians regularly face conversations about information that patients have found online. Given the prevalence of misinformation, these conversations can include cancer-related misinformation, which is often harmful. Clinicians are in a key position as trusted sources of information to educate patients. However, there is no research on clinician-patient conversations about cancer-related misinformation. As a first step, the objective of this study was to describe how cancer clinicians report communicating with patients about online cancer misinformation. METHODS We used convenience and snowball sampling to contact 59 cancer clinicians by e-mail. Contacted clinicians predominately worked at academic centers across the United States. Clinicians who agreed participated in semistructured interviews about communication in health care. For this study, we focused specifically on clinicians' experiences discussing online cancer-related misinformation with patients. We conducted a thematic analysis using a constant comparative approach to identify how clinicians address misinformation during clinical visits. RESULTS Twenty-one cancer clinicians participated in the study. Nineteen were physicians, one was a physician assistant, and one was a nurse practitioner. The majority (62%) were female. We identified four themes that describe how cancer clinicians address misinformation: (1) work to understand the misinformation; (2) correct misinformation through education; (3) advise about future online searches, and (4) preserve the clinician-patient relationship. CONCLUSION Our study identified four strategies that clinicians use to address online cancer-related misinformation with their patients. These findings provide a foundation for future research, allowing us to test these strategies in larger samples to examine their effectiveness.
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Affiliation(s)
- Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Michaela D Mullis
- College of Journalism and Communications, University of Florida, Gainesville, FL
| | - Jordan Alpert
- College of Journalism and Communications, University of Florida, Gainesville, FL
| | - Merry Jennifer Markham
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL
| | - Tracy Onega
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT
| | - Carla L Fisher
- College of Journalism and Communications, University of Florida, Gainesville, FL
| | - Skyler B Johnson
- Department of Radiation Oncology, School of Medicine, University of Utah, Salt Lake City, UT
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Sanders R, Araujo TB, Vliegenthart R, van Eenbergen MC, van Weert JCM, Linn AJ. Patients' Convergence of Mass and Interpersonal Communication on an Online Forum: Hybrid Methods Analysis. J Med Internet Res 2020; 22:e18303. [PMID: 33074160 PMCID: PMC7605979 DOI: 10.2196/18303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/12/2020] [Accepted: 06/21/2020] [Indexed: 12/15/2022] Open
Abstract
Background Patients are increasingly taking an active role in their health. In doing so, they combine both mass and interpersonal media to gratify their cognitive and affective needs (ie, convergence). Owing to methodological challenges when studying convergence, a detailed view of how patients are using different types of media for needs fulfillment is lacking. Objective The aim of this study was to obtain insight into the frequency of reported convergence, how convergence affects what posters write online, motives for posting, and the needs posters are trying to fulfill. Methods Using a hybrid method of content analysis and supervised machine learning, this study used naturally available data to fill this research gap. We analyzed opening posts (N=1708) of an online forum targeting cancer patients and their relatives (Kanker.nl). Results Nearly one-third of the forum opening posts contained signs of convergence in mass or interpersonal media. Posts containing mass media references disclosed less personal information and were more geared toward community enhancement and sharing experiences compared to posts without convergence. Furthermore, compared to posts without signs of convergence, posts that included interpersonal media references disclosed more personal information, and posters were more likely to ask for the experiences of fellow users to fulfill their needs. Within posts containing signs of convergence, posts including interpersonal media references reported fewer shortages of information, disclosed more information about the disease, and were more active in seeking other posters’ experiences compared to posts containing mass media references. Conclusions The current study highlights the intertwining of media platforms for patients. The insights of this study can be used to adapt the health care system toward a new type of health information–seeking behavior in which one medium is not trusted to fulfill all needs. Instead, providers should incorporate the intertwinement of sources by providing patients with reliable websites and forums through which they can fulfill their needs.
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Affiliation(s)
- Remco Sanders
- Department of Communication Science, Amsterdam School of Communication Research, Univeristy of Amsterdam, Amsterdam, Netherlands
| | - Theo B Araujo
- Department of Communication Science, Amsterdam School of Communication Research, Univeristy of Amsterdam, Amsterdam, Netherlands
| | - Rens Vliegenthart
- Department of Communication Science, Amsterdam School of Communication Research, Univeristy of Amsterdam, Amsterdam, Netherlands
| | - Mies C van Eenbergen
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Julia C M van Weert
- Department of Communication Science, Amsterdam School of Communication Research, Univeristy of Amsterdam, Amsterdam, Netherlands
| | - Annemiek J Linn
- Department of Communication Science, Amsterdam School of Communication Research, Univeristy of Amsterdam, Amsterdam, Netherlands
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Linn AJ, Schouten BC, Sanders R, van Weert JCM, Bylund CL. Talking about Dr. Google: Communication strategies used by nurse practitioners and patients with inflammatory bowel disease in the Netherlands to discuss online health information. PATIENT EDUCATION AND COUNSELING 2020; 103:1216-1222. [PMID: 32098743 DOI: 10.1016/j.pec.2020.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/15/2020] [Accepted: 01/18/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study explores how patients with Inflammatory Bowel Disease (IBD) and nurse practitioners (NPs) in the Netherlands communicate about online health information-seeking. METHODS We analyzed 165 consultations of patients at the start of maintenance treatment using grounded theory. Consultations in which the words; internet, website, Google, Googled, webpages, online (forum/blog/platform) or a website was mentioned, were included. Segments were identified and analyzed that represented a discussion about online health information-seeking (n = 87). We coded the initiator, initiation and reaction communication strategy. RESULTS Half of the sample was female, most patients were moderately to highly educated and aged on average 48 years. One third of the consultations included a discussion about online health information-seeking. Seventeen communication initiation and reactions strategies were identified. Patients and NPs were equally as likely to initiate a neutral discussion about online health information-seeking. Patients repeatedly reacted with disclosing their concerns. NPs responded by taking patients' online health information-seeking seriously or affirming patients' beliefs. CONCLUSION This exploration makes a unique contribution by demonstrating that NPs particularly adopt a patient-centered communication style while communicating about patients' online health information-seeking. PRACTICE IMPLICATIONS Results of this study could guide interventions to train providers in talking about patients' online health information-seeking.
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Affiliation(s)
- Annemiek J Linn
- University of Amsterdam, Amsterdam School of Communication Research (ASCoR), Amsterdam, the Netherlands.
| | - Barbara C Schouten
- University of Amsterdam, Amsterdam School of Communication Research (ASCoR), Amsterdam, the Netherlands
| | - Remco Sanders
- University of Amsterdam, Amsterdam School of Communication Research (ASCoR), Amsterdam, the Netherlands
| | - Julia C M van Weert
- University of Amsterdam, Amsterdam School of Communication Research (ASCoR), Amsterdam, the Netherlands
| | - Carma L Bylund
- University of Amsterdam, Amsterdam School of Communication Research (ASCoR), Amsterdam, the Netherlands
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Shen MJ, Dyson RC, D'Agostino TA, Ostroff JS, Dickler MN, Heerdt AS, Bylund CL. Cancer-related internet information communication between oncologists and patients with breast cancer: a qualitative study. Psychooncology 2015; 24:1439-47. [PMID: 25631285 DOI: 10.1002/pon.3752] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 11/30/2014] [Accepted: 12/18/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Many patients with cancer search out information about their cancer on the internet, thus affecting their relationship with their oncologists. An in-depth analysis of patient-physician communication about information obtained from the internet is currently lacking. METHODS We audio-recorded visits of patients with breast cancer and their oncologists where internet information was expected to be discussed. Inductive thematic text analysis was used to identify qualitative themes from these conversations. RESULTS Twenty-one patients self-reported discussing cancer-related internet information (CRII) with their oncologists; 16 audio recordings contained detectable discussions of CRII and were analyzed. Results indicated that oncologists and patients initiated CRII discussions implicitly and explicitly. Oncologists responded positively to patient-initiated CRII discussions by (1) acknowledging their limited expertise/knowledge, (2) encouraging/approving using the internet as an information resource, (3) providing information/guidance on the proper use of internet searches, (4) discussing the pros and cons of relevant treatment options, or (5) giving information. Finally, patients reacted to the CRII discussions by (1) indicating that they only used reputable sources/websites, (2) asking for further explanation of information, (3) expressing continued concern, or (4) asking for the oncologist's opinion or recommendation. CONCLUSIONS These results indicate that the majority of patients introduce internet information implicitly, in order to guard against any threat to their self-esteem. Physicians, in turn, seem to respond in a supportive fashion to reduce any threat experienced. Future interventions may consider providing prescription-based guidance on how to navigate the internet as a health information resource and to encourage patients to bring these topics up with their oncologist.
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Affiliation(s)
| | - Robert C Dyson
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | | | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Maura N Dickler
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | | | - Carma L Bylund
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA.,Hamad Medical Corporation, Doha, Qatar
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Nguyen SKA, Ingledew PA. Tangled in the breast cancer web: an evaluation of the usage of web-based information resources by breast cancer patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:662-668. [PMID: 23832398 DOI: 10.1007/s13187-013-0509-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study describes Internet use by breast cancer patients highlighting search patterns and examining the impact of web-based information on the clinical encounter. From September 2011 to January 2012, breast cancer patients at a cancer center completed a survey. Answers were closed and open-ended. Eighty-one patients were approached and 56 completed the survey. Forty-five (80 %) respondents used the Internet and 32 (71 %) searched for breast cancer information. All used Google as their principal search engine. To evaluate quality, 47 % referred to author credentials and 41 % examined references. Most sought information with respect to treatment or prognosis. Eighty percent felt that the information increased their knowledge and influenced treatment decision making for 53 %. This study highlights search patterns and factors used by breast cancer patients in seeking web-based information. Physicians must appreciate that patients use the Internet and address discrepancies between information sought and that which is available.
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